Decision to widen access to influenza vaccine

28 March 2022

Medicines Decision

What we’re doing

We're pleased to announce that we are widening access to influenza vaccine from 1 April 2022 for Māori and Pacific peoples who are 55-64 years of age, for the duration of the 2022 calendar year. This is to reduce the impact of influenza to high-risk populations during the COVID-19 pandemic.

This decision means that more people can access funded influenza vaccine from 1 April 2022. We estimate that approximately an additional 39,000 people, who may not already be eligible, would be able to receive funded influenza vaccine.

Many Māori and Pacific peoples from 55 to 64 years of age may already be eligible for funded influenza vaccine if they have other serious health conditions such as asthma, diabetes, or heart disease. Earlier access at a younger age would mean that more Māori and Pacific peoples could benefit from funded influenza vaccination, as a smaller proportion of the population is 65 years or older (to be eligible under the present criteria) than other population groups. Eligibility from an earlier age will also reduce health system barriers to accessing funded influenza vaccination, as eligible people would not need to have already accessed health services to receive a diagnosis of a qualifying condition.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 8 March 2022.

We’re really grateful for the time people took to respond to this consultation. Many people who responded were supportive of the proposal and we received many suggestions for additional groups, including younger ages for Māori and Pacific People that could also be funded.

After considering all the feedback received, we have decided not to make any changes to the original proposal. We will, however, seek clinical advice from our Immunisation Advisory Committee about the additional groups requested for funding so we can assess these requests before the 2023 influenza season.

A summary of the main themes raised in feedback and our responses to the feedback received are summarised below.

Who we think will be most interested

Māori and Pacific peoples from 55 to 64 years of age and their whānau
Doctors in general practice, pharmacists, nurses and vaccinators
DHBs
Suppliers and wholesalers
Organisations with an interest in Māori and Pacific health
Organisations with an interest in immunisation

Detail about this decision

From 1 April 2022, funded access to influenza vaccine will be widened to include Māori and Pacific peoples from 55-64 years of age.

The following changes to influenza vaccine eligibility criteria will occur in Section I of the Pharmaceutical Schedule (additions in bold):

	INFLUENZA VACCINE – people 3 years and over
is available each year for patients aged 3 years and over who meet the following criteria, as set by Pharmac:
all people 65 years of age and over; or
people 55 to 64 years of age (inclusive) who are Māori or any Pacific ethnicity; or
people under 65 years of age who:
have any of the following cardiovascular diseases:
ischaemic heart disease, or
congestive heart failure, or
rheumatic heart disease, or
congenital heart disease, or
cerebro-vascular disease; or

have either of the following chronic respiratory diseases:
asthma, if on a regular preventative therapy, or
other chronic respiratory disease with impaired lung function; or

have diabetes; or
have chronic renal disease; or
have any cancer, excluding basal and squamous skin cancers if not invasive; or
have any of the following other conditions:
autoimmune disease, or
immune suppression or immune deficiency, or
HIV, or
transplant recipients, or
neuromuscular and CNS diseases/disorders, or
haemoglobinopathies, or
are children on long term aspirin, or
have a cochlear implant, or
errors of metabolism at risk of major metabolic decompensation, or
pre and post splenectomy, or
down syndrome, or

are pregnant; or

children 3 and 4 years of age (inclusive) who have been hospitalised for respiratory illness or have a history of significant respiratory illness;

Unless meeting the criteria set out above, the following conditions are excluded from funding:
asthma not requiring regular preventative therapy,
hypertension and/or dyslipidaemia without evidence of end-organ disease.


Contractors will be entitled to claim payment from the Funder for the supply of influenza vaccine to patients eligible under the above criteria pursuant to their contract with their DHB for subsidised immunisation, and they may only do so in respect of the influenza vaccine listed in the Pharmaceutical Schedule.
Contractors may only claim for patient populations within the criteria that are covered by their contract, which may be a sub-set of the population described in paragraph A above.

The following changes will be made to Part II of Section H of the Pharmaceutical Schedule (additions in bold):

Restricted

Initiation - People of Māori or any Pacific ethnicity

People 55 to 64 years of age (inclusive) who are Māori or any Pacific ethnicity.

Our response to what you told us

We’re really grateful for the time people took to respond to this consultation. A summary of the main themes raised in feedback, our responses to the feedback received are shown below:

Theme	Comment
Support for the proposal	We acknowledge the thoughtful responses that many people and organisations took the time to submit in support of the proposal.
Do not support ethnicity-based criteria	Māori and Pacific populations have a younger age distribution than other population groups and high incidence of comorbidities. Our clinical advisors told us that Māori and Pacific peoples are at increased risk from seasonal influenza, but influenza vaccination uptake in Māori and Pacific peoples is lower than the wider population. Widening access from an earlier age would increase coverage in Māori and Pacific Peoples as a greater proportion of the population would be able access funded vaccination without the need to access healthcare services to confirm eligibility under comorbidity related criteria.
Request ongoing funding of the proposed group beyond the 2022 influenza season	Widened access for this group of people is in the context of increased risk of poor outcomes related to reduced immunity to influenza due to public health measures to manage COVID-19. Widened access for future years would need to be considered against other proposals on our options for investment list(external link). We intend to seek clinical advice at our next Immunisation Advisory Committee meeting on a funding proposal for ongoing funding of this population beyond the 2022 season.
Request funding for additional groups of people including: Children 6 months to 5 years Everyone Everyone from 55 years Māori and Pacific peoples from 45 years Māori and Pacific peoples from 50 years Mental Health and addiction Former refugees	We are grateful for the suggestions of additional groups that could be funded for influenza vaccine. We note that vaccine supply quantities have already been allocated for New Zealand, and there may not be sufficient vaccine available to fund the wider groups requested. We note that there were submissions suggesting that the lower age should be either 45 or 50 years and we intend to seek further clinical advice on this at our next Immunisation Advisory Group meeting. A proposal for people with serious mental health issues or addiction has received a positive recommendation from our Immunisation Advisory Committee and will be ranked on the Options for Investment list. You can view more about this on our Application Tracker(external link). We intend to seek further clinical advice from the Immunisation Advisory Committee so that we can consider further options for wider access for the groups requested in the consultation feedback for the flu 2023 season. We would welcome any supporting evidence to inform our consideration of the additional groups
Questions about how vaccinators will determine ethnicity	We acknowledge the concern that frontline staff may encounter difficult situations if they need to enforce eligibility criteria by requiring proof of ethnicity. We consider that requesting proof of ethnicity before vaccination would put an additional access barrier in place for a group that already has barriers to accessing health services. It is over to individual providers to satisfy themselves that the person presenting for vaccination meets the eligibility criteria. Ethnicity is self-defined by the person and is included in everyone’s NHI. Ethnicity should be recorded in general practice records and pharmacy software. If someone has identified as a particular ethnicity, that is a defining ethnicity.
Concerns about increased sector workload	The Ministry of Health has advised us it has a number of workstreams in progress to reduce the impact on workload of the traditional vaccinator workforce.
Suggestions for successful implementation of the proposal	We acknowledge the helpful suggestions to maximise uptake in Māori and Pacific populations. The Ministry of Health is responsible for the implementation of vaccination programmes, including the commissioning of vaccinator services, so we will share the suggestions with the Ministry of Health.
Concerns about permanently widening vaccinator workforce to include a non-regulated vaccinating health worker role	The decision to widen access to influenza vaccine does not include any changes to the vaccinator role. The Ministry of Health is responsible for the implementation of vaccination programmes, including the commissioning of vaccinator services, so we will share these concerns with the Ministry.

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 660 050.